West Nile virus neuroinvasive disease: neurological manifestations and prospective longitudinal outcomes.
West Nile virus neuroinvasive disease: neurological manifestations and prospective longitudinal outcomes.
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DOI：
10.1186/1471-2334-14-248
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发表时间：
2014-05-09
影响因子：
3.7
通讯作者：
NIAID Collaborative Antiviral Study Group West Nile Virus 210 Protocol Team
中科院分区：
文献类型：
--
作者：
Hart J Jr;Tillman G;Kraut MA;Chiang HS;Strain JF;Li Y;Agrawal AG;Jester P;Gnann JW Jr;Whitley RJ;NIAID Collaborative Antiviral Study Group West Nile Virus 210 Protocol Team
西尼罗河病毒（WNV）是一种蚊媒黄病毒，自1999年以来一直在美国引起季节性流行病。据估计，≤ 1%的WNV感染患者将发生神经侵袭性疾病（西尼罗河脑炎和/或肌炎），可导致衰弱性发病和长期后遗症。重要的是要收集有关恢复过程的纵向信息，并描述可能有助于未来治疗决策的预测因素。我们报告了一项纵向研究的神经功能的结果（通过神经系统检查，奶牛昏迷量表，和改良的简易精神状态检查）为55例受试者与西尼罗河病毒神经侵袭性疾病（阳性CSF IgM确认）在第7天，出院时，并在第14天，30日和90日进行评估。神经学结局指标为昏迷（存在和程度）、整体认知状态、存在颅神经病变、震颤和/或虚弱。在最初的临床表现中，93%的患者表现为明显的神经功能缺损（49%的患者表现为虚弱，35%的患者表现为震颤，16%的患者表现为颅神经病变）。有认知缺陷的患者人数从最初评估时的25人下降到最后评估时的9人。9例患者在发病时存在颅神经病变，研究结束时仅4例患者存在颅神经病变。在入组时有震颤的19例患者中，11例在随访时继续表现出震颤。7名患者在首次入组研究后死亡，其中5名患者处于昏迷状态。预测神经功能严重程度或长期恢复的因素包括年龄（老年人在随访检查时较弱）、性别（男性从昏迷中恢复得更好）和昏迷伴颅神经缺损（恢复较差，特别是在认知方面）。这项研究是最大的临床研究之一，提供了美国西尼罗河病毒中枢神经系统疾病患者前瞻性获得的神经系统结局数据。研究结果表明，从最初的表现影响预后的因素包括年龄，性别和发病时的特定神经功能缺损。ClinicalTrials.gov
West Nile Virus (WNV) is a mosquito-borne flavivirus that has caused ongoing seasonal epidemics in the United States since 1999. It is estimated that ≤1% of WNV-infected patients will develop neuroinvasive disease (West Nile encephalitis and/or myelitis) that can result in debilitating morbidities and long-term sequelae. It is essential to collect longitudinal information about the recovery process and to characterize predicative factors that may assist in therapeutic decision-making in the future. We report a longitudinal study of the neurological outcomes (as measured by neurological examination, Glascow Coma Scale, and Modified Mini-Mental State Examination) for 55 subjects with WNV neuroinvasive disease (confirmed by positive CSF IgM) assessed on day 7, at discharge, and on days 14, 30, and 90. The neurological outcome measures were coma (presence and degree), global cognitive status, presence of cranial neuropathy, tremors and/or weakness. At initial clinical presentation 93% presented with a significant neurological deficit (49% with weakness, 35% with tremor, and 16% with cranial neuropathy). The number of patients with a cognitive deficit fell from 25 at initial evaluation to 9 at their last evaluation. Cranial neuropathy was present in 9 at onset and in only 4 patients at study conclusion. Of the 19 patients who had a tremor at enrollment, 11 continued to exhibit a tremor at follow-up. Seven patients died after initial enrollment in the study, with 5 of those having presented in a coma. The factors that predict either severity or long-term recovery of neurological function include age (older individuals were weaker at follow-up examination), gender (males recovered better from coma), and presentation in a coma with cranial nerve deficits (had a poorer recovery particularly with regard to cognition). This study represents one of the largest clinical investigations providing prospectively-acquired neurological outcomes data among American patients with WNV central nervous system disease. The findings show that the factors that influence prognosis from the initial presentation include age, gender, and specific neurological deficits at onset. ClinicalTrials.gov identifier: NCT00138463 and NCT00069316.
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DOI：
10.3390/v6020606
发表时间：
2014-02-06
期刊：
Viruses
影响因子：
--
作者：
Sejvar JJ
通讯作者：
Sejvar JJ
影响因子：
2.6
作者：
Tombaugh, TN
通讯作者：
Tombaugh, TN
影响因子：
158.5
作者：
Nash, D;Mostashari, F;Smith, P
通讯作者：
Smith, P
影响因子：
4.4
作者：
Cao, NJY;Ranganathan, C;Li, J
通讯作者：
Li, J
影响因子：
28.2
作者：
Saad, M;Youssef, S;Moorman, J
通讯作者：
Moorman, J